Effects of psychotropic switches on weight change: a prospective cohort study

Introduction

Many psychotropic drugs can induce weight gain with differences in their metabolic risk profiles (i.e. high, medium or low-risk).

Objectives

To compare the weight evolution of patients switching versus patients keeping their psychotropic drugs with different risk-profiles.

Methods

Data for patients switching or keeping the same drug were obtained from the Psyclin (from 2007 to 2015) and Psymetab (2007- 2019) cohort studies, conducted at the Lausanne University Hospital, Switzerland. Patients either switched from a high to a low-risk, a high to a medium-risk, a medium to a low-risk drug, or for a drug with the same risk category. Patients not switching either kept a high, medium or low-risk drug. The evolution of weight is currently being analyzed using a linear mixed-effect model.

Results

Preliminary results showed that switching from a high to low-risk molecule had the strongest impact on weight changes. The analysis being ongoing, the quantitative results will be presented at the congress.

Conclusions

Switching from a high-risk to a low-risk molecule is likely to have the strongest impact on weight changes.

Disclosure

No significant relationships.

Inter-informant agreement and prevalence estimates for substance use disorders: direct interview versus family history method

OBJECTIVES

Family studies typically use multiple sources of information on each individual including direct interviews and family history information. The aims of the present study were to: (1) assess agreement for diagnoses of specific substance use disorders between direct interviews and the family history method; (2) compare prevalence estimates according to the two methods; (3) test strategies to approximate prevalence estimates according to family history reports to those based on direct interviews; (4) determine covariates of inter-informant agreement; and (5) identify covariates that affect the likelihood of reporting disorders by informants.

METHODS

Analyses were based on family study data which included 1621 distinct informant (first-degree relatives and spouses) - index subject pairs.

RESULTS

Our main findings were: (1) inter-informant agreement was fair to good for all substance disorders, except for alcohol abuse; (2) the family history method underestimated the prevalence of drug but not alcohol use disorders; (3) lowering diagnostic thresholds for drug disorders and combining multiple family histories increased the accuracy of prevalence estimates for these disorders according to the family history method; (4) female sex of index subjects was associated with higher agreement for nearly all disorders; and (5) informants who themselves had a history of the same substance use disorder were more likely to report this disorder in their relatives, which entails the risk of overestimation of the size of familial aggregation.

CONCLUSION

Our findings have important implications for the best-estimate procedure applied in family studies.

Meta-analysis shows schizophrenia is not associated with the 40-base-pair repeat polymorphism of the dopamine transporter gene

OBJECTIVE

Several case-control studies examined an association between schizophrenia and the 40-bp variable number tandem repeat (VTNR) polymorphism in the 3'-UTR of the dopamine transporter gene (SLC6A3). The results of these studies have been equivocal due to small sample size and low power. This meta-analysis has the aim to evaluate the collective evidence for an association between the VTNR polymorphism and schizophrenia.

METHOD

Different meta-analyses were performed, sequentially considering the 9- and 10-repeat alleles and different genotypes (genotypes 9/9, 9/10, 10/10) as risk factors for schizophrenia. Analyses of the alleles included 659 cases and 563 controls from six case-control studies.

RESULTS

The pooled OR from each analysis approximated 1.0, and none were significant. Lack of significance attributable to the negative effects of single large studies or to heterogeneity between the studies was excluded.

CONCLUSION

Despite over 90% power to detect a significant odds ratio as small as 1.3, no association was observed. Considering the cumulative evidence from six case-control studies and results from additional family-based studies, it seems unlikely that the 40-base-pair VTNR polymorphism of the SLC6A3 gene influences risk for schizophrenia.

Antitrust issues for medical groups

Many medical groups may not regularly seek legal advice in regard to all the various business transactions in which they participate. Unlike hospitals, medical groups do not usually retain specialized health care law firms. As this professional paper illustrates, it is important for medical group administrators to have some familiarity with antitrust issues. This knowledge is important for administrators in two contexts: First, to keep their own groups from having antitrust problems; and second, to keep a watch on their competitors to be sure that the group's position is not compromised by any illegal activities engaged in by these entities.